目的 探討沙利度胺聯(lián)合甲地孕酮輔助治療晚期乳腺癌對(duì)脂糖代謝及免疫功能的影響。方法 收集2013年10月—2017年10月，陜西省漢中市中心醫(yī)院接受治療的61例晚期乳腺癌患者，根據(jù)治療方法不同，分為聯(lián)合組（n=31）和對(duì)照組（n=30），對(duì)照組給予沙利度胺及常規(guī)化療，聯(lián)合組在對(duì)照組的基礎(chǔ)上給予甲地孕酮治療，均連續(xù)治療3個(gè)月。比較兩組臨床療效、治療期間不良反應(yīng)的發(fā)生率，分析兩組治療前后脂糖代謝功能及免疫指標(biāo)水平變化。結(jié)果 聯(lián)合組和對(duì)照組的客觀緩解率（ORR）分別為54.84%和30.00%，聯(lián)合組的ORR明顯高于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05），但兩組病情控制率（DCR）相比差異無(wú)統(tǒng)計(jì)學(xué)意義。與治療前相比，治療后兩組IgG、IgA水平均明顯下降，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05），而聯(lián)合組治療后IgG、IgA水平均顯著高于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。經(jīng)過(guò)3個(gè)月的治療后，聯(lián)合組有9例（29.03%）出現(xiàn)糖代謝異常，4例（12.90%）診斷為2型糖尿病，糖代謝異常率為41.94%，明顯低于對(duì)照組的66.67%（P<0.05）；治療期間，兩組均出現(xiàn)不同程度的胃腸道反應(yīng)和骨髓抑制，其中聯(lián)合組不良反應(yīng)發(fā)生率明顯低于對(duì)照組（P<0.05）。結(jié)論 甲地孕酮聯(lián)合沙利度胺輔助治療晚期乳腺癌，療效顯著，可減少不良反應(yīng)及晚期乳腺癌患者糖代謝異常的發(fā)生，改善患者免疫功能。

Objective To investigate the effects of thalidomide combined with megestrol on lipid metabolism and immune function in patients with advanced breast cancer.Methods Selected 61 patients with advanced breast cancer were treated in Hanzhong Central Hospital of Shaanxi Province, from October 2013 to October 2017. All patients were divided into control group (n=30) and combined group (n=31) by treatment method. The control group was treated with thalidomide and conventional chemotherapy. The combined group was given megestrol on the basis of the control group. The clinical efficacy and the incidence of adverse reactions during the treatment between two groups were compared. To analyse the changes of Metabolic function and immune Indexes of Lipid and glucose in two groups.Results The ORR of the combined group and the control group were 54.84% and 30.00%. The ORR of the combined group was significantly higher than control group (P<0.05), but there was no significant difference in DCR between the two groups. After treatment, the level of IgG, IgA in both groups decreased significantly (P<0.05), while the level of IgG, IgA in the combined group was significantly higher than that in the control group (P<0.05). After 3 months of treatment, 9 patients in the combined group (29.03%) showed abnormal glucose metabolism, and 4 patients with type 2 diabetes mellitus, the abnormal rate of glucose metabolism was 41.94%, which was significantly lower than that in the control group (P<0.05). During the treatment period,gastrointestinal reaction and bone marrow suppression occurred on different degrees in both groups,and the incidence of adverse reactions in the combined group was significantly lower than that in the control group(P<0.05). Conclusions Megestrol acetate combined with thalidomide for advanced breast cancer,have a significant effect,and can reduce the incidence of adverse reactions in patients with advanced breast cancer and sugar metabolism,improve immune function of patients.